Deep extubation versus no-touch awake extubation in adults undergoing elective laparotomy: A randomised controlled trial.

BACKGROUND AND AIMS: Tracheal extubation is a vulnerable phase of general anaesthesia. Smooth extubation strategies aim to reduce cough, bucking, and the sympathetic surge. This trial compared deep extubation with no-touch awake extubation in adults undergoing elective laparotomy. METHODS: This prospective, randomised, partially outcome-assessor-blinded trial enroled American Society of Anesthesiologists (ASA) physical status I-II adults scheduled for elective laparotomy, allocated to deep extubation (Group D) or no-touch awake extubation (Group N). The primary outcome was cough (grade ≥1) within five minutes of extubation. Secondary outcomes were cough severity, airway adverse events, airway support, haemodynamics, and recovery characteristics. RESULTS: Seventy patients (35 per group) were analysed. Cough occurred in 3 (8.6%) patients in Group D and 8 (22.9%) in Group N (P = 0.18). Deep extubation was associated with more desaturation below 95% (11 vs 2; P = 0.009), more breath-holding (8 vs 1; P = 0.028), greater need for airway support, and four re-intubations versus none. Recovery times were shorter in Group D. The heart rate and blood pressure were higher in Group N during early recovery. CONCLUSION: Deep extubation did not significantly reduce cough and was associated with more airway-related adverse events and airway support needs, including reintubation. Shorter recovery times and less moderate-to-severe cough in Group D did not reduce these risks. The findings do not support routine use of deep extubation and need confirmation in a larger, adequately powered trial.